St John's Medical Centre

Updated 8 November 2016

St John's Medical Centre is based in purpose built premises in Lewisham, south east London. There is a ramp access into the building, and a lift to the doctors’ rooms on the first floor. A hearing loop is in place. There is good access to public transport, and parking is available on nearby streets. A number of other health services are based in same building.

Eleven doctors work at the practice: three male and eight female. Three of the doctors are partners (with a management partner) and there are eight salaried GPs (one male, seven female). Some of the GPs work part-time. Full time doctors work eight sessions per week. The practice has 65 GP sessions per week.

The (all female) nursing team is made up of a nurse manager, three practice nurses and two health care assistants. Some of the nurses work part-time, with all of the nursing hours adding up to just over four whole time equivalents (or full-time roles).

The practice trains junior doctors as GPs, and takes nursing students for placements.

The practice is open 8 am to 6.30pm Monday to Friday. Appointments with GPs are from 8 am to 12 pm every weekday morning (12.30 pm on Monday and Wednesday) and 2 pm to 6.30 pm every week day afternoon (apart from Wednesday when clinics begin at 2.30 pm). Extended hours appointments are offered from 7 am on Tuesday and 7.30 am on Wednesday, and until 7pm on Thursday. Appointments are also available on the first Saturday of the month from 8am to 11.30am.

When the practice is closed cover is provided by SELDOC, a GP co-operative that runs out-of-hours care.

There are approximately 13,725 patients at the practice. Compared to the England average, the practice has more young children as patients (age up to four) and fewer older children (age 5 – 19). There are more patients aged 20 – 49, and many fewer patients aged 50+ than at an average GP practice in England.

The surgery is based in an area with a deprivation score of four out of 10 (1 being the most deprived), and has a higher level of income deprivation affecting older people and children.

The practice offers GP services under a Personal Medical Services contract in the Lewisham Clinical Commissioning Group area. The practice is registered with the CQC to provide family planning, surgical procedures, diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services.

This is the first time that the CQC has inspected the practice.

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St John's Medical Centre on 21 September 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national average for most indicators. The practice was aware of the areas for development and had plans in place to achieve this.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Consider reviewing complaints periodically to identify trends and facilitate learning. .
• Review the procedure for maintaining staff files to ensure that they are complete.
• Continue to improve care for patients with long term conditions, particularly patients with Chronic Obstructive Pulmonary Disorder, and to reduce rates of patients excepted from Quality and Outcomes Framework indicators.
• Consider ways to reduce waiting times for patients.
• Consider developing a wider programme of audit, to improve services and outcomes for patients.
• Review the new system for checking urgent referrals, to check that it is working as anticipated.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 November 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Data from 2014/15 showed that performance for diabetes related indicators was comparable to the national average. For example, 70% of patients with diabetes, had their HbA1c (blood sugar over time) last measured at 64 mmol/mol or less, compared to the local average of 73% and the national average of 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice referred patients to education programmes to support self-management of diabetes and respiratory conditions.
• All clinical staff members had received training in collaborative care planning.

Updated 8 November 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• To support families the practice ran a ‘one stop shop’ for mothers’ postnatal and new baby checks with a GP and a health visitor. These were booked automatically based on the hospital notes.

Updated 8 November 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. 10% of patients over the age of 65 had documented care plans in place.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• 73% of patients aged over 65 received a flu vaccination in 2015/16, compared to the local average of 69%.

Updated 8 November 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice had installed a blood pressure machine in the waiting room to support patients to self-monitor their blood pressure, height and weight.

Updated 8 November 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Performance for mental health related indicators was similar to the national average.
• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan; compared to the national average of 88%. Seventy four percent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 8 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.